Holiday heart syndrome presents in form of irregular heartbeat patterns among otherwise healthy individuals who take too much alcohol. Alcohol consumption affects your cardiovascular system, and much of the research conducted has mainly focused on the beneficial effects of moderate alcohol consumption along with the harmful consequences. Consuming alcohol in large quantities may result in dilated cardiomyopathy. A lesser known effect of alcohol consumption is its association with arrhythmia.
In early 70s, it was reported that there was a link between acute alcohol consumption and the start of arrhythmia. Philip Ettinger first gave a description of Holiday heart syndrome in 1978. In healthy people who do not have heart disease like arrhythmia, they may experience acute cardiac rhythm disturbances or atrial fibrillation when they drink heavily. Most of the episodes involving atrial fibrillation following binge drinking were mostly observed during public holidays or after weekends hence the name of the disorder.
In a 1987 study involving 24 patients presenting to the hospital at the time of holidays seeking treatment for atrial fibrillation, it was found that all were healthy individuals but they had one thing in common. The individuals took alcohol heavily during that time, or they were regular drinkers who engaged in binge drinking during the holiday season.
How Alcohol Causes Cardiac Arrhythmia
Atrial fibrillation (AF) is the most frequent form of cardiac arrhythmia in Holiday heart syndrome (HHS). It is not clearly known how alcohol results in cardiac arrhythmia; however, there may be direct or indirect relationship of the two. Alcohol myotoxicity may occur in patients who consume alcohol, showing a direct effect. Also, it is believed that alcohol derived metabolites may also bring about cardiac arrhythmia like atrial fibrillation, showing an indirect relationship. Another thing is that alcohol may have effects on other body organs like adrenal glands.
The scientific community has come up with different theories explaining how alcohol consumption leads to atrial fibrillation and they include:
Cardiac conduction interference: When an individual indulges in acute alcohol consumption, it may interfere with the heart’s conduction system by slowing down the conduction. The cardiac conduction system comprises specialized muscle cells found in the walls of an individual’s heart. The cardiac cells transmit signals to muscle of the heart making it contract. In the cardiac conduction system, the main components are AV node, SA node, bundle branches, bundles of His, and Purkinje fibers. Cardiac conduction is important in that it enables re-entry, and the re-entry is among the mechanisms that are associated with incidents of cardiac arrhythmias like atrial fibrillation.
Increased sympathetic activity: Taking alcohol in excess can increase the production of catecholamines by the medulla of the adrenal gland or by the myocardium. When this happens, there is prolonged P-waves, a situation that is linked to atrial arrhythmia.
Refractory period shortening: It is likely that alcohol may shorten atrial refractory leading to cardiac arrhythmia. This observation has been made in rat atrial tissue. In a study that involved 11 alcohol abusers, researchers did not observe significant changes in the atrial refractory after taking whiskey meaning that there may be additional focal conduction alterations that facilitate re-entry resulting in cardiac arrhythmia.
Increased plasma free fatty acids: When individuals take alcohol, there is an increase in plasma free fatty acids believed to be arrhythmogenic. The mechanisms may not be clearly understood, however, there has been a link between atrial fibrillation and elevated free fatty acids among elderly. This has been seen in a recent analysis of a Cardiovascular Health Study something that strengthens the theory.
Increased parasympathetic activity: Apart from sympathetic activity causing cardiac arrhythmia in alcohol users, a recent study has also found out that vagal activation is linked to paroxysmal atrial fibrillation. Alcohol may also trigger atrial fibrillation through vagal activation since most patients with arrhythmia due to alcohol intake were likely to report vagal activation.
Acetaldehyde arrhythmogenic effects: Metabolites of alcohol may have arrhythmogenic properties by heightening both systemic and intra-myocardial catecholamines. The arrythmogenic effect presented by acetaldehyde may be caused by an increase in adrenergic activity according to a study in dog Purkinje fibers.
Symptoms of Holiday Heart Syndrome
Patients having holiday heart syndrome are otherwise healthy and may not have family or personal history of heart palpitations. The individuals may not have suggestive symptoms associated with structural cardiac anomalies. In these patients, there is no clinical evidence of having heart diseases like vascular disease, cardiomyopathy, or coronary heart disease. The laboratory tests of the individuals are seen to be normal.
In electrocardiograms, when the patient returns to normal sinus rhythm, the readings are usually normal. There are no new episodes occurring in the patients when they abstain from alcohol, no recurrence of symptoms even with continued use of alcohol. This observation shows that alcohol leads to the development of arrhythmia and avoiding binge drinking or heavy consumption of alcoholic drinks can prevent the reoccurrence of the disorder.
People with holiday heart syndrome have symptoms like:
- Palpitations
- Precordial pain or pressure
- Dyspnea
- Syncope
It’s is also possible for atrial fibrillation to occur without a patient having any clinical symptoms. This means that it may be difficult to detect or diagnose some episodes of holiday heart syndrome something that may result in underestimation of the incidences.
Complications
Atrial fibrillation experienced in people with holiday heart syndrome has been indicated to be a risk factor for having a stroke. AF may also increase the risk of mortality or death. However, while there is a connection between holiday heart syndrome and stroke or death, there is no suggestive clinical data that supports the outcomes, especially in people with holiday heart syndrome. What’s more, arrhythmia linked to HHS following heavy drinking may result in sudden death. This may explain why incidents of sudden death are commonly witnessed in alcoholics.
Is Alcohol the Only Cause for Holiday Heart Syndrome?
Besides alcohol being implicated as a risk factor and possible cause of atrial fibrillation around the holidays, there are other things as well that may be associated with the episodes of holiday heart syndrome.
Overeating: It is common to have people overeat during holidays. But taking a large amount of food within one sitting may make the stomach and bowels to extend and distend so as to accommodate the content. When this happens, it may activate the nervous system in the body referred to as parasympathetic or vagal nervous system. This is what people use to digest food, sleep, and have rest. If the vagal system is activated, it slows down the heart rate.
In people who are more susceptible to having atrial fibrillation, tiny areas within the upper chambers can be triggered and begin to beat fast resulting in anomalies with their heart rhythm. Such areas are found within the small veins draining blood from the individual’s lungs to the upper side of the left heart chamber.
Salt consumption: Having too much salt intake may also be associated with holiday heart syndrome. The body needs salt, however, when we have too much of it, it is likely to cause fluid retention. This, in turn, causes an increase in blood pressure. In people having a history of hypertension or high blood pressure and other problems like heart failure and heart valve problems, the increased blood pressure along with fluid retention may cause the upper heart chambers to stretch resulting in atrial fibrillation.
Heart attacks: Having heart injury is something common during holidays. It has been observed that most deadly heart attacks tend to occur on December 25 when compared to other days of the year. The attacks are also common on December 26 and January 1. The reason the heart attacks occur during these times is that of depression, overeating, cold weather, and relay in routine check-ups because people are busy with their holiday celebrations. Any heart injury can cause irritation, especially to the upper heart chambers leading to anomalies in heart rhythm.
Stress and dehydration may also contribute to atrial fibrillation among HHS patients.
Treatment of Holiday Heart Syndrome
In patients who present to the emergency room complaining of tachyarrhythmia that is secondary to heavy alcohol intake, they are observed with an electrocardiogram. Treatment may be in form of atrioventricular nodal blocking agents and they include verapamil, beta blockers, and diltiazem. These medications are needed if a person has an excessive ventricular rate.
When atrial fibrillation is seen to approach 24 to 48 hours, a doctor may use cardioversion to obviate the need of having anticoagulation. If atrial fibrillation lasts for more than 48 hours, a doctor may use pericardioversion anticoagulation to treat the patient.
Most patients that have structural heart disease may need to be admitted so that close monitoring is done if arrhythmia persists.
In summary, alcohol plays a role in cardiac arrhythmia, whether through binge drinking or chronic abuse. It is important for doctors to identify holiday heart syndrome. Patients should refrain from binge drinking to avoid having incidents of holiday heart syndrome. With proper treatment, Holiday heart syndrome may not present serious health issues, however, a patient should watch their drinking and probably avoid it prevent the return of their HHS because the condition can have complications that are as serious as a stroke or sudden death.
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